Research of hospitalization, outcomes and follow-up results of extremely low birth weight infants

Abstract

Objective To investigate the hospitalization, outcomes and follow-up results of extremely low birth weight infant (ELBWI). Methods From 1 January 2010 to 31 May 2016, a total of 276 cases of ELBWI who were hospitalized in neonatal intensive care unit of 10 medical institutions, including Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region, Maternal & Child Health Hospital of Yulin, Maternal & Child Health Hospital of Qinzhou, etc., were chosen as research subjects. Clinical case data and follow-up results of the ELBWI were analyzed retrospectively, including general clinical data of ELBWI and their mothers, common clinical symptoms, complications, sequelaes and follow-up conditions of ELBWI. Among survival and discharged ELBWI, the respiratory therapy between gestational age <28 weeks and ≥28-32 weeks ELBWI were compared statistically by chi-square test and Mann-Whitney U test. This study was in line with World Medical Association Declaration of Helsinki revised in 2013. Results ① General informations of 209 mothers of ELBWI in this study: the twin pregnancy rate was 31.6% (66/209). Top three pregnancy complications in turn of 209 mothers were premature rupture of membrane (27.3%, 57/209), gestational hypertension diseases (19.6%, 41/209) and gestational diabetes mellitus (17.7%, 37/209). ②Top four clinical symptoms in turn of 276 cases of ELBWI in neonatal period were dyspnea (91.7%, 253/276), poor response (75.7%, 209/276), cyanosis of lips or whole body (67.8%, 187/276) and abdominal distention (40.6%, 112/276). ③Top six complications in turn of 276 cases of ELBWI in neonatal period were hyperbilirubinemia (81.2%, 224/276), respiratory distress syndrome (RDS) (75.7%, 209/276), anemia of prematurity (64.1%, 177/276), intrauterine infectious pneumonia (50.0%, 138/276), bronchopulmonary dysplasia (BPD) (48.6%, 134/276) and sepsis (45.7%, 126/276). ④Among 128 cases of ELBWI who were alive and discharged from hospitals, the rate of treatment and duration of respirator assisted ventilation of ELBWI with gestational age <28 weeks were 92.6% and 8.0 d (3.0-16.0 d), respectively, the rate of treatment and duration of continuous positive airway pressure (CPAP) of ELBWI with gestational age <28 weeks were 96.3% and 16.0 d (11.0-25.0 d), respectively, which were all much higher or longer than those of 67.2%, 2.0 d (0-7.5 d), 73.4%, 7.5 d (0-20.0 d) in ELBWI with gestational age ≥28-32 weeks, and all differences were statistically significant (χ2=11.321, P=0.001; Z=-3.994, P<0.001; χ2=11.329, P=0.001; Z=-3.301, P=0.001). ⑤ The survival rate of 276 cases of ELBWI in this study was 46.4%(128/276). Among 276 cases of ELBWI, a total of 88 cases were cured and 40 cases were improved when discharged from hospitals, and 137 cases (49.6%) died in hospitals as ineffective treatments (36 cases) or their guardians gave up treatment to their ELBWI (101 cases), and outcomes of another 11 cases was unknown after they discharged from hospitals by their guardians′ signature. ⑥ Follow-up results of 128 alive and discharged cases showed that 25 cases followed up uncompleted, and the missing rate in this study was 19.5% (25/128). Among 103 cases of ELBWI who followed up successfully, 4 of them died within 6 months after birth. Among infants who have completed follow-up, 48.1%(39/81) of them failed to pass the auditory brainstem response audiometry test, 69.4% (59/85) of them had been diagnosed of retinopathy of prematurity (ROP). Among 99 survival cases who were followed up successfully, ratio of motor and language development retardation were 27.3% (27/99) and 17.2% (17/99), respectively, and only 37.4% (37/99) of them assessed by Gesell Developmental Scale or followed up regularly in neonatology/rehabilitation department. Conclusions The twin birth, premature rupture of membrane and gestational hypertension diseases of mother are the common causes of ELBWI. There are many complications and high mortality rate during the neonatal period of ELBWI. We should take close follow-up after ELBWI discharging from hospitals. Key words: Hospitalization; Outcomes; Evoked potentials, auditory, brain stem; Retinopathy of prematurity; Survival rate; Infant, extremely low birth weight